Maynard, MA, USA: Beacon-Villager newspaper column on local history, observations on nature and recreational activities, plus an occasional health-related article. Columns from 2009-11 collected into book "MAYNARD: History and Life Outdoors." Columns from 2012-14 collected into book "Hidden History of Maynard." - David A. Mark

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Thursday, August 15, 2013

Anaplasmosis - the Other Tick Disease

There is a new kid in town - Anaplasma phagocytophilium. This bacterium is carried by the same
deer ticks that bring us Lyme disease. Prime time for tick diseases is May
through August. The symptoms are different but the course of action is the same
- get diagnosed, get treated.

Lyme disease signs and symptoms start subtly. If the
stricken person missed the actual bite, then the first sign is often (but not
always) the signature rash. Fever, chills, fatigue, muscle ache and a headache
may (or may not) accompany the rash. Only after weeks to months after the rash
(which does not always occur) and the initial set of symptoms (ditto) are gone is there a possibility that the really bad consequences set in: arthritis,
partial facial paralysis, meningitis, limb weakness, and so forth (or not).

In stark contrast, the symptoms of anaplasmosis are more
akin to being run over by a car, having it circle around to hit you again, and
then one more time to park on your head. Or in gamers' terms, "All your
base." [Look it up.]

Some 7 to 10 days after the bite the anaplasmosis symptoms arrive all at
once: extreme fatigue, high fever, uncontrollable shivering alternating with profuse
sweating, night sweats, headache, nausea, abdominal pain, loss of appetite,
muscle pain, cough, mental confusion, and extreme fatigue. Really extreme. The Centers for Disease Control (CDC) uses the term "malaise," but this does not convey the
soul-crushing lethargy of a full-speed Anaplasma
assault.

Not everyone exhibits all the symptoms, and many of these symptoms
overlap with the flu and other diseases, either causing many people to delay
seeking a medical evaluation, or doing so and getting a misdiagnosis.

Actually, these days a diagnosis is straightforward. Do you
have some or all of that litany of symptoms, especially fever and fatigue? Were
you in any place a week or two ago where there might have been ticks? Do you
have any symptoms which hint you may have something else? If not the last, that's it. A blood
sample will be taken, but early in the course of the infection the
test results can be falsely negative (results say you don't, but you do). Standard
medical practice is to start antibiotic treatment immediately. Treatment should
never be delayed until the lab results are back. Standard treatment is the same
as for Lyme - two weeks of doxycycline.

Not treating an Anaplasma infection in a timely fashion can
have serious consequences. Especially in older or immuno-compromised people
there are risks of compromised breathing, kidney failure, nerve damage...
Treatment may require hospitalization and intravenous antibiotics. Deaths are
rare (less than one percent).

Anaplasmosis does not appear to be casually contagious. As a
blood-borne disease it could in theory have the same vector as HIV/AIDS, but
there is no mention in the science literature of transmission via sexual
contact. There are confirmed reports of infection from blood donations, and in
theory the same risk would apply to organ transplant recipients. Currently
there are no good blood or organ donor screening tests.

As noted, Anaplasma
is carried by the same tick as Lyme disease. Reported cases of Lyme number
about 30,000 per year. This is accepted as an undercount, as many people do not
seek medical assistance, and so were never diagnosed. Others sought medical
help and were misdiagnosed (keep in mind the false negative problem with blood
tests also applies to Lyme). And finally, some were correctly diagnosed but not
reported to the appropriate health agency. With the same caveats in mind, the
anaplasmosis report for 2010 (the latest year with national data) was 1,761
cases. Hotspots for both diseases are the Northeast and the upper Midwest.

NEWS FLASH: On August 18, 2013, the Centers for Disease Control revised its estimates of numbers of new Lyme disease cases per year from 30,000 to 300,000. This 10X increase was the result of survey blood testing laboratories for numbers of positive blood tests, versus the old method of depending solely on reports from physicians. All physicians are supposed to report all confirmed or suspected Lyme disease to the CDC, but obviously, this has not been true. It is likely that other tick borne diseases are under reported.

More information on tick-vector diseases can
be seen as the CDC website: http://www.cdc.gov/ticks/.
The CDC has great information on the tick diseases, and also on practical
matters such as how to avoid getting bitten by a tick, and what to do once you
have been bitten. You can even download a 21-page handbook: Tickborne Diseases
of the United States. Another site with a good pictoral of the life cycle and high risk months is www.aldf.com/DeerTickEcology.shtml.

One small, small benefit from having survived an
anaplasmosis infection is that if someone asks how you are, and you answer
"I've been worse," you are telling the truth.

In addition to Lyme and Anaplasma, deer ticks may also transmit babesiosis (a parasite disease) and Powassan virus. Babesiosis is rarer than Anaplasma, and Powassan is extremely rare. Other diseases are transmitted by other tick species in other regions of the country. Visit the CDC website for details.